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May 10, 2013

BG Testing – Use First or Second Drop?

Have you heard about this before? I
admit I had not and I wondered what the significance could be. There
is more significance than thought and I will try to cover the reasons
and considerations. This originally appeared in February 2012, but
has been getting some attention on several diabetes forums again.
Some are concerned and others are trying to play it down as old news.
I have found that old news can be just as valuable for people
recently diagnosed with diabetes because they may not be aware of the
old news. On June 15, 2012, the diabetes blog on the Mayo Clinic diabetes page had this blog.

This is a Dutch study and the full text is free at this link. You will need a PDF reader. When they are
talking about diabetes educators, they are referring to diabetes
educators in Europe. Even these educators give different advice
although the majority of the Dutch educators advised patients to wash
their hands before testing. To address the different
recommendations, they used the following to measure the capillary
glucose concentrations. They also compared readings of greater than
or equal reading of 10%.

#1. without washing hands

#2. after handling fruit

#3. after washing the fruit-exposed
fingers

#4. during the application of different
amounts of external pressure around the finger (squeezing).

For measuring equipment, the
researchers used the Accu-Chek Compact plus meter with
plasma-calibrated test strips (Roche, Almere, the Netherlands). The
meter was calibrated prior to the start of the study as well as
halfway through the study. No significant changes were observed.

A Speidel and Keller hand blood
pressure meter was used to achieve different external pressures. The
regular cuff was replaced by a neonatal cuff. One of two available
sizes was used depending on the thickness of the finger (Philips,
M1866A neonatal disposable cuff #1 and M1868A neonatal disposable
cuff #2). This equipment was used to apply standard pressure for the
finger pressure we often refer to as milking the finger.

Time interval during measurements were
done so that capillary glucose measurements were performed directly
following the finger puncture with a maximum delay of 90 seconds
between measurements. When using the cuffs, the selected pressure
was applied first and then the finger puncture was performed. The
two pressures were 40 mmHg and 240 mmHg.

The interesting part of this study is
the differences among the educators in their recommendations and then
what the patients do in practice. Even more surprising was the
number of patients that did not use the side of their fingers for
testing.

The conclusions were about what I
expected and only one source mentioned what I think many forget in
talking about using the second drop of blood. When using the second
drop of blood, the lancet must be set deeper, therefore potentially
creating more pain in testing to be able to wipe the first drop away
and to be able to have a second drop form. The authors do recommend
washing hands with soap and water, drying them, and using the first
drop of blood.

The authors do recommend using the
second drop when washing is not possible and the fingers are not
visibly soiled or have not been expose to sugar-containing foods or
products. They tell us to wipe away the first drop of blood and use
the second. They wisely and with proof from their study advise us
not to use external pressure as this creates unreliable results.
This applies to testing when the fingers have been exposed to fruit
sugars and need to be washed for accurate results.

When using pressure or milking the
finger, we need to be concerned about interstitial fluids affecting
the results. This is what makes them unreliable. Also by using the
second drop, the depth of the lancet can create unwanted pain, but is
necessary to obtain the second drop of blood.

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About Me

I am enjoying life, despite diabetes type 2. I am retired and enjoying the time I have for writing and photography. I was diagnosed with type 2 on Oct 2003, on oral meds for 4 months and they were doing nothing to really improve my daily readings. By cutting my carbohydrates I received the most improvement, but still not enough. Then I requested insulin, even though I did not like the thought of needles. That brought about the biggest change and A1c's in the lower 6's and upper 5's. Now I am working at maintaining them under 6.0 and hopefully nearer 5.5.